Harvest Safety Team Volunteer Application

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Harvest Safety Team Volunteer Application General Information: Date: _____________

Name: ________________________________________________

Address: ________________________ City: ______________ State: ________ Zip: _________ Cell Phone: ____________________

Work Phone: ________________________

E-mail Address: ____________________________________________ Date of Birth: _______/________/_______ Are you a member of Harvest Bible Church?

Yes / No

Do you regularly attend our worship services?

Yes / No

If yes, when did you start attending? ______________________ (approx. date) Ministry Information Are you currently serving in another church Ministry? If so, please list: ______________________________________________________________________________ I desire to serve on the safety team at Harvest because….. ______________________________________________________________________________ ______________________________________________________________________________ Please write your salvation testimony below: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Have you read and do you support the beliefs and doctrinal statement of Harvest Bible Church? Yes / No

Personal Information Disclosure: Please circle appropriate response 1. Is there any fact, circumstance, or pattern involving your background that would make it inappropriate for you to be near minors or would compromise the integrity of the church? Yes / No If yes please explain: _____________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 2. Have you ever been known by any other name? Yes / No

If so:__________________

Church History and Ministry experience Previous church work involving safety/security (list each organization name, city, state, and type of work performed): _______________________________________________________________ _______________________________________________________________ Previous non-church work involving safety/security (list each organization name, city, state, and type of work performed): ___________________________________________________________ ___________________________________________________________ Applicant’s Statement: I understand that Harvest Bible Church is a “Mandatory Reporter” and will contact the local authorities first if there is any accusation of abuse: Yes / No I understand that Harvest Bible Church has a “Zero Tolerance” policy for any inappropriate touch or talk with children. The volunteer will be dismissed immediately and authorities contacted if the situation warrants it. Yes / No I grant Harvest Bible Church, Westland MI permission to initiate a police background check. Yes / No The information contained in this application is correct to the best of my knowledge. I authorize any references, churches, organizations listed in this application to give you any information (including opinions) that they have regarding my character and fitness for safety/security ministry. I authorize the release of the information contained in this application to any individuals who make decisions about placing applicants in available positions. Applicant’s Signature: ________________________________________________________

Criminal Records Check Authorization Form Important: Every applicant, regardless of criminal record, must complete this section. I hereby request and authorize the release of any information which pertains to any record of convictions contained in law enforcement files or any criminal file maintained on me whether local, state, or national. I hereby release local, state, and national law enforcement agencies from any and all liability resulting from such disclosure. The information contained in this application is correct to the best of my knowledge. I hereby authorize Harvest Bible Church and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigate consumer report to be generated for volunteer purposes. I understand the scope of the consumer report may include, but is not limited to the following areas: verification of social security number; current and previous residences; employment history, education background, character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public record. I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to Harvest Bible Church or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources. I hereby release Harvest Bible Church and any individual, church, youth organization, charity, employer, reference, and any other person or organization, including record custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply, with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application. Applicant’s Signature: ______________________________ Date: ________________________

Background Check Information Form This information on this form will be used to run your background check. Upon completion of background check this information will be shredded and disposed. The application information will be stored in a locked office. Harvest Bible Church processes background checks through our Kidcheck system. Please create a Kidcheck account. Go to go.kidcheck.com and create an account. Cell number on kidcheck account: _______ - ______ - __________ First, Middle, Last Name (Print):___________________________________________________ Date of birth: ____/____/____ Social Security Number:_________________________________ Driver’s license number and state: __________________________________________________